Free - - Mississippi

F0030 - Page 1 of 1

OFFICE OF THE MISSISSIPPI SECRETARY OF STATE
P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333

Application for Amended Certificate of Authority For Foreign Corporations
The undersigned, pursuant to Section 79-4-15.04 (if a profit corporation) or Section 79-11-369 (if a nonprofit corporation) of the Mississippi Code of 1972, hereby executes the following document and sets forth:

1. Type of Corporation Profit 2. Name of the Corporation Nonprofit

3. The Name of the Corporation is changed to

4. The future effective date is (Complete if applicable) 5. The state or country of its incorporation is changed to

6. The period of duration is changed to By: Signature
(Please keep writing within blocks)

Printed Name

Title

Rev. 01/96